Healthcare Provider Details

I. General information

NPI: 1720454655
Provider Name (Legal Business Name): VILLAGE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 CHRUCH AVE SUITE B
CHULA VISTA CA
91910-2729
US

IV. Provider business mailing address

276 CHRUCH AVE SUITE B
CHULA VISTA CA
91910-2729
US

V. Phone/Fax

Practice location:
  • Phone: 619-651-8939
  • Fax: 619-362-9616
Mailing address:
  • Phone: 619-651-8939
  • Fax: 619-362-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JOSHUA SAMEER PAL
Title or Position: PRESIDENT
Credential: MD
Phone: 619-651-8939